=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245024900
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDY VICTOR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2025
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1481 MCDONALD AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11230-4667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-491-7333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 209 MAIN ST
-----------------------------------------------------
City | KEYPORT
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07735-1466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-271-0220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 0000000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------